Few would dispute that curbing rising rates of obesity is one of the greatest public health challenges of the 21st Century, yet as a nation, we grapple with how to talk about being fat. The Centers for Disease Control and Prevention even dances around the subject by labeling overweight kids "at risk for overweight" and obese kids "overweight."
One might argue that labeling any kids or adults is wrong, but you can’t solve the problem unless you name it and quantify it. Well, we’ve quantified it. Roughly one-third of adults are obese and two-thirds are overweight.
So now, we have to do something about this grossly expensive epidemic. Some employers facing ballooning health costs have taken punitive approaches to push their workers to lose weight. But arms flew up aghast when Chicago’s police chief dared to say that all officers must pass a physical fitness test. The police department already has a voluntary program that provides a $250 bonus to the cops that pass. Voluntary, clearly didn’t work
Some obesity experts say these punitive approaches to reduce obesity won’t work, and in fact, they are discriminating. Some have coined this "weightism."
Researchers at Yale University published a paper last month in the International Journal of Obesity saying discrimination based on weight is as much of a problem in American society as discrimination based on race or gender, especially for women and individuals with a Body Mass Index of 35 or higher (a 200 pound 5’4" person has a BMI of 35).
Many contributing factors to obesity are beyond individual control and simply suggesting that people exercise more and eat less probably won’t work, especially if you live in a neighborhood without safe streets and parks and no healthy food. But some behaviors are within our control, and progress cannot be made if political correctness overtakes frank discussions.
I asked one of the Yale study’s lead authors, Rebecca Puhl, about the study, discrimination and possible solutions to the obesity epidemic. Here are her answers:
The study was based on data from 1995-1996. The number of overweight and obese people has grown substantially since then. Thus, would you expect your conclusions of the percent of people who experience discrimination based on their weight to be greater?
We actually controlled for increasing obesity rates in our statistical analysis, so we can confidently conclude that the findings do not reflect increases in obesity, but rather reflect increases in reported experiences of weight discrimination.
Isn’t discrimination based on weight fundamentally different discrimination based on sex, race or disability? Why do you or don’t you agree?
Because people often assume that body weight is "a choice", they feel that it shouldn’t be considered a legitimate form of stigma or discrimination. This is wrong. The causes of obesity are very complex, and to assume that obesity is a choice significantly oversimplies the notion that significant weight loss can be sustained over time. Only a small percentage of people can reach this goal. A large body of science using randomized clinical control trials show poor long-term results in the ability to sustain significant weight loss over time – even with intensive and expensive treatment options. This had led to a greater appreciation of the role that biology plays in regulating body weight, and in the difficulty of sustaining weight loss over time. So, we need to challenge the common assumption that body weight is simply an issue of willpower, and consider the science about the causes and treatment of obesity. I think we also need to question whether a person needs to justify a genetic or biological predisposition for their obesity in order to receive the basic human right of equality. The answer to that is no.
Do you believe discriminating against obese people is wrong? Why? The World Health Organization currently will not hire people who smoke. What if they said they would not hire people with a BMI of 30 (5’4" woman who weights 180 pounds)? Is this the same or different?
Discriminating against an individual because of his or her weight is certainly wrong. It is also important to recognize that BMI is not necessarily an automatic or accurate indicator of health. There are many individuals who are not overweight who are very unhealthy (who, for example, may have high blood pressure or cholesterol), and similarly there are people who are overweight who are in good health and whose blood pressure and cholesterol are in the normal range.
Currently, many large employers are experimenting with wellness programs to help their employees adopt healthy behaviors and thereby reduce health costs. Obese and overweight people and smokers are the primary target of such plans. Is this discrimination?
Rather than imposing penalties on individuals who have a certain BMI or who smoke, which can become discriminatory, a better way for companies to address increasing costs associated with obesity or smoking is to initiate and support social changes that can help change the conditions that create obesity in the first place (such as increasing access of affordable healthy foods, providing opportunities for physical activity, and promoting healthy work environments where it is easy for employees to be healthy.Wellness programs that reward people for making healthy lifestyle changes through improved eating habits or physical activity is much more appropriate and doesn’t discriminate people based on weight. Poor diet and physical inactivity are hurting everybody ñ not just those who are overweight. So incentive programs that reward healthy behaviors offer a much broader umbrella under which people can be supported to become healthier, regardless of their body weight.
While significant contributing factors to obesity, such as environment and genetics, are not behavioral. Many other factors are, thus changing behaviors and social norms is a must to curb rates of obesity. Given the difficulty in changing behaviors but the incredible expense associated with obesity, what solutions do you propose to curb obesity rates that do not "discriminate" against this population?
Currently, our culture is taking a "personal responsibility" approach to try to reduce obesity. We have a billion dollar diet industry that is based on this premise, and thousands of diet books, pills, and plans. But obesity rates continue to rise, and this approach is clearly not working. We need to make major changes in our environment to make it easier for people to be healthy.(As I mentioned above, this can include increasing access and advertising of affordable healthy foods, providing opportunities for physical activity, and promoting healthy work environments where it is easy for employees to be healthy.)
There is also discrimination against people that are underweight or even just skinny. I am 5’10 and weigh 145 lbs. I eat healthy, about 3000 calories a day, and exercise 4 times a week with a little running and weight lifting. According the the BMI I am right where I need to be, not underweight whatsoever. Apparently to the rest of America though, I look anorexic. Society judges way too much. Being healthy is much more important than your weight. I look skinny to some, but in reality I am in tip top shape. My friends parents always want me to eat more. I just ate as much as your overweight son, clearly I am full. Due to the fact that I am skinny means that I must still be hungry. The discrimination goes both ways. I cant imagine what it would be like to be a naturally skinny women. I feel like people would assume you are anorexic or something. Too much judging in America. We are all critics. Be Healthy. Stay Fit. Live Long.
I agree with Dr. Michael J Hollis, although I wish overweight people would take more responsibility and not blame the media, fast food, and society.
Why is a mandate for weight control problematic in an institution where physical fitness is an asset? Cops are crime-fighters. Crime-fighting is perceived as a rigorous activity involving apprehension and restraint. All better performed by a body acclimated to agility and strength. Easy to say, I suppose.
Friends of mine in the policing industry would offer a more comprehensive rebuttal. “Being a cop is more than beating up bad guys and throwing people in jail,” one friend would say while reminding me, “We probably spend more time sitting around writing reports, waiting in municipal court houses, and negotiating disputes between neighbors. Putting a premium on fitness, alone, ignores the most important asset an officer of the law has – communication and problem-solving skills.”
That said, being a healthy role model and having self-confidence are assets in just about any job, including law-enforcement. For a police chief to stress the importance of a modest level of physical proficiency would be applauded by concerned public if every police officer seen “walking the beat” were gasping for air while criminals were running rings around them. In a similar vein, I suppose an environmentalist would be applauded for suggesting we clean up the air if police officers and laymen alike were walking around gasping for air because the air was polluted. With this in mind, perhaps the police chief was stressing the importance of the condition, rather than condemning a particular group of people.
Talk to someone who’s overweight. In most cases, you’ll find them just as hard-working and committed to their health as anyone else. The trouble is, as a society, we haven’t figured out why some people can, for example, eat pizza every day and stay perfectly thin while others eat the same thing and have out-of-control weight problems.
In our clinic, we’re learning to throw concepts, like calorimetry and “low calorie” out the window. These terms are being replaced by notions of individuality and metabolic balancing. We try to apply the “let’s see if the pizza will work for you” rule before having the “pizza is bad and all other foods that bring a smile to your face are bad, too” talk. We believe that, if a person who has a particular opinion about their own body image wants to work on themselves, that they should be able to get results if they are prepared to do the work.
Why this philosophy? Because the most disappointing thing is meeting someone who’s spent years trying to control weight, but their lifestyle and dieting efforts simply didn’t match their body chemistry. All that effort for no result. It’s no surprise people just give up. Nobody should have to work relentlessly for no gain.
Maybe the police chief needs to touch on some methods that will create a more positive outlook for his workers. Yes, some of his people are getting a little older, a little slower, and maybe putting on a few extra pounds. Aging and sitting in a car all day will do that to you. What if he found a group of professionals that could offer promise to workers leaning towards self-improvement by giving them the option to get tested properly? What if these tests would then tell them how their body works – and help them select a lifestyle and diet program that matches their body chemistry – rather than some generic program that only works for less than 10 percent of us? This, so that a program is selected not for weight loss, per se, but one that is selected to best match the body’s natural chemical rhythms. Weight loss – better yet, body normalization – is only one of numerous positive outcomes when an individualized program such as this is selected.
To ignore amassing statistical evidence on obesity to be more sensitive to people who don’t want to be categorized and/or judged as obese is beside the point. We need to search for ways to help people achieve personal goals – whether they want to lose or gain weight, or just be happier. For those who want to lose weight, weight loss strategies have a pretty dismal reputation for longevity – partly because our paradigm for evaluating success suggests there is one magic diet out there that works for everyone equally. Not so.
Peter is on the right track…good food is so expensive that it’s economically counter-intuitive not to eat fast and processed food. If you do want to eat well and healthily (which not everyone can afford) it becomes a lifestyle choice that is likely to require compromises in other areas of your life.
Yes, the system is against us. Our culture glamorizes thinness and bombards us with food advertising at the same time. How much more of a mixed message could there be?
GEM, I don’t know of the specific reason why it’s so hard for you to control your weight but the system is against you because it’s cheaper to grow and ship calories than nutrition. Especially when they’re subsidized.
As someone who has suffered from obesity for most of my life I feel torn when I read an article like this one and especially the posts. I like that the researcher’s points about issues of stigma and overweight/obesity and I feel sad when I read the posts. If losing weight were so easy then there wouldn’t be any fat people but clearly it’s not. Being overweight/obese is painful and hard. I’ve been on every diet there is starting at age 11 on weight watchers, with the usual story of losing and gaining. I recently had bariatric surgery and have finally lost a significant amount of weight but it’s still a battle. We look at thin people and automatically assume they are healthy which often isn’t the case. I know plenty of overweight women that work out 5-6 days a week. As a nation it would be helpful if we view the obesity epidemic as not a problem with the individual but one that requires institutional and societal changes, more work place wellness, cheaper/low cost gym memberships, safer neighborhoods. Finally we need to stop comparing ourselves to Europe it really serves no useful purpose. So what they drink, eat a ton of olive oil and smoke and are “healthy” that’s their experience and it’s never going to be the American story.
I’m not opposed to group pressure to reduce rates of obesity at all. It just seems to me we can’t even talk about the issues yet. I’m actually concerned that so-called “weightism” issues will impede meaningful and important discussion. For instance, something like half of parents with overweight children don’t realize they’re overweight. Well, someone’s gotta tell them and that shouldn’t be considered prejudicial. In elementary school, all the kids get vision and hearing screenings. Now they need BMI screenings and the results sent home to parents.
I posted this article because I thought the researchers’ had an interesting point, though I don’t entirely agree with it. For most people, I don’t believe being overweight can be considered an equal point of discrimination as gender or race. I think by continuing down a path of destructive behavior individuals are limiting their own options.
Still, I always wonder how much of my opinion in this matter is biased by the fact I was blessed with a high metabolism and athleticism. It’s easy to judge others until we’ve had their experiences. The environment — in terms of having safe places to walk, public transportation and healthy food available at affordable prices — is a HUGE factor contributing to obesity. The focus of interventions should be at an environmental, community and individual level.
“According to Michael Pollan”
I assume tcoyote you’ve read his, “The Omnivore’s Dilema”? Another book of his is, “In Defense of Food”. These are must reads for anyone interested in knowing why we’re fat and why the present subsidized industrial food system is making us sick, not to mention the concentration camp methods we use to raise animals.
Agree w/ R Baer. According to Michael Pollan, we’ve increased our per capita sugar intake by 25% since 1985 w/o increasing our physical activity. The fact that we are hardwired to seek carbohydrates genetically sets the stage for ruinous changes in our body weight. People who do not take steps to control their carb intake get trapped metabolically, and it becomes very difficult to reset the body. The explosion in obesity was not genetically based, however. It resulted from personal choices and dreadful dietary habits. Travel abroad to places like Italy or Spain where people love to eat, and smoke more than we do, and it is shocking to see how little obesity there is. As John Kennedy would have said, “We can do bettah!”.
How did we bring down adult smoking? By making it much more expensive to buy cigarettes and by making people more aware of the health risks to the point where smoking was no longer “sexy”, but a willful act of stupidity. People can change their behavior through both positive encouragement and higher cost. Obesity among adults is leveling off, and few people who are obese wish to be. If we focus our attention on this by intelligent health benefit design, tax policy and public awareness of the need for physical activity, we can begin to get control over this increasingly serious public health problem.
Why not combine “personal responsibility” and environmental change? They are not mutually exclusive.
Ms. Arnquist believes that there should be no form of group pressure with regards to being normalweight and leading a healthy lifestyle. I think that she is mistaken. Yes, group pressure is stupid and has the inherent tendency to escalate into discrimination. However, the same force makes people not only to mow their lawns, but also not to avoid neglecting and (at least publicly) hitting their children, to stop smoking when people are around, to listen to each other without yelling or fighting … if you take the element of responsibility/group pressure away, you undermine free will (cannot virtually any bad tendency/trait be explained with factors you can’t influence, either the genes or the circumstances) and progress with regards to obesity.
But of course, educate people about a healthy lifestyle and diet, make sure that they do not have to work 2.5 jobs just to barely survive, give tax rebates for fresh produce and raise the tax on corn syrup and microwaveable bacon. But being morbidly obese is not OK – it is a problem that needs to be taken care of, society may help (and should not discriminate), but primary responsibility is with the overweight individual.